Predictors and trends of opioid-sparing radical prostatectomy from a large national cohort.
Academic Article
Overview
abstract
OBJECTIVE: To examine the use of pain medications after radical prostatectomy using a large national database. METHODS: The Premier Hospital Database was queried to identify all robotic and laparoscopic radical prostatectomies from January 2015 - March 2020 with length of stay ≥1 day. "Opioid-sparing" was defined as absence of intravenous opioid use after post-operative day 0 and absence of oral opioid use throughout admission. Comparisons were made between opioid-sparing and non-opioid-sparing prostatectomy. Logistic multivariable regression was used to identify predictors of opioid-sparing prostatectomy. RESULTS: A total of 62,660 patients were included, of whom 14,806 (23.6%) underwent opioid-sparing prostatectomy. Opioid-sparing prostatectomy was associated with older age (65 vs. 63 years, p<0.01), white vs. black race (76.3% vs. 73.4%, p<0.01), high-volume surgeons (75.2% vs. 70.0%, p<0.01), and use of intravenous ketorolac (62.2% vs. 48.0%, p<0.01), intravenous acetaminophen (32.5% vs. 30.1%, p<0.01), and liposomal bupivacaine (5.4% vs. 4.9%, p<0.01). On multivariable regression, ketorolac was the strongest predictor of opioid-sparing prostatectomy (odds ratio: 1.86, 95% confidence interval: 1.79 - 1.93, p<0.01), and black race was predictive of non-opioid sparing prostatectomy (odds ratio: 0.75, 95% confidence interval: 0.71 - 0.80, P<0.01). Ketorolac was not associated with increased risk of postoperative bleeding (0.3% vs. 0.3%, p=1.0) or dialysis requirement (<0.1% vs. <0.1%, p=0.91). CONCLUSION: Opioid-sparing radical prostatectomy was feasible and associated with administration of each of the non-opioid pain medications assessed. Ketorolac was the strongest predictor of opioid-sparing prostatectomy and was not associated with increased risk of bleeding or dialysis.
